Atrial fibrillation (AF) occurs in up to approximately thirty-five percent of patients in the postoperative period after cardiac surgery. This postoperative complication is associated with increased hospital costs, which average as much as $8000 per patient, as well as increased morbidity and mortality. Postoperative atrial fibrillation (pAF) increases the length of a patient's stay in an intensive care unit and a hospital generally, and can result in a low cardiac output state and hemodynamic instability, blood clot formation in the heart (i.e., atria) that can embolize to the lungs to cause pulmonary embolus, to the brain, resulting in stroke, and to other end organs, such as the kidneys, causing acute renal failure, the intestines, causing mesenteric ischemia, and the limbs, potentially resulting in the loss of the limb.
The treatment of pAF depends on the associated clinical findings. If the patient is hemodynamically unstable, they undergo urgent direct current cardioversion (DCCV). If the patient is stable, the goals of treatment are either heart rate control via a pharmacologic agent or rhythm control via elective DCCV. Each of these treatments requires either antiarrhythmic medication administration (e.g., amiodarone, procainamide) or DCCV, which requires one or both of airway management and procedural sedation. If the patient remains in AF, they will require long term anticoagulation therapy that increases the risk of bleeding, for example, in the brain or gastrointestinal tract and requires continued monitoring. AF is poorly understood and the cause is not known. There are presently no known methods to prevent it or to predict it.